The widening scandal at the U.S. Department of Veterans Affairs, which led to the ouster of Secretary Eric Shinseki last week and could fell a number of other officials, is sparking a broader debate about whether the agency should be overhauled after a decade of rapid expansion.

The VA operates 150 hospitals, more than 1,000 health clinics and 131 cemeteries. It buries, houses, educates, hospitalizes, loans money to, and insures the lives of millions of veterans each year. And the veterans who intersect with the agency span decades of government service, from World War II survivors to those recently returning home from Iraq and Afghanistan.

Even with a falling number of veterans – the total stands at less than 22 million compared with 23 million in 2010 — the volume of veterans seeking health care and enrolling in disability benefits continues to grow. More than 3.5 million veterans now collect disability payments, up more than 33% in 10 years. The VA’s annual budget now exceeds $150 billion, a sum that is often authorized by Congress with little second guessing.

But the number and needs of veterans is changing faster than the large agency designed to serve them, and revelations about widespread medical scheduling improprieties has prompted calls for a broader shake up than firing Mr. Shinseki and finding a new secretary to lead the VA.

“There needs to be a discussion about what changes need to take place to make sure that vets are getting access to care in a timely manner, and then that this is being done in a cost-effective way,” said former VA Secretary Anthony Principi, a Republican.

There are a number of changes that could come into focus. Congress could decide to revamp the way veterans receive health care, possibly by liberalizing rules about seeking care at non-VA hospitals. It could also streamline or consolidate some of the VA’s housing or job-training programs, for example, which are similar to those offered by other federal agencies.

Changes, though, have proven to be complex and must have broad support from veterans groups to win consideration. Several veterans groups believe it is important to have programs tailored to the needs and conditions of former service members, and programs serving vets tend to have more ironclad budgets than programs run by other agencies.

Previous efforts to redesign the agency have seen mixed results. In 2003, the VA began a controversial effort to close a number of underused VA hospitals, streamline the health care offered at others, and build new ones in places where the large number of nearby veterans strained the existing infrastructure. The results were mixed, with modest changes to some hospitals while the infrastructure was kept largely intact. The agency has tried to build a number of new hospitals in recent years. Some have been delayed for years, and others have seen their budgets grow far beyond initial estimates.

Veterans Affairs Secretary Eric Shinseki resigned Friday.

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A frequent target of many calling for reform is the VA’s sprawling regional chain of command, which critics allege has allowed senior officials to operate with too much autonomy and with little oversight, either from top VA brass or Congress.

“You’ve got a bloated hierarchy that has so many layers that you can’t get information from the bottom up and you can’t get oversight from the top down,” said Paul Light, a professor of public service at New York University. “The agency is rife with inefficiency.”

Joseph Violante, legislative director of Disabled American Veterans, said the group “wants to sit down with Congress and figure out how to make the system work better,” but cautioned against any effort to ratchet back the scale of how the VA interacts with veterans.

“I don’t think it’s too big to manage,” Mr. Violante said of the agency. “I think you need not only strong leadership in the secretary, but strong leadership in the under secretaries. And you need strong oversight to make sure the money being given to the VA is being spent wisely.”

Agency officials have said changes are underway, and it has spelled out some ambitious goals.

In a December report to Congress, Mr. Shinseki wrote, “We are transforming the VA into a 21st century organization focused on increasing Veterans’ access to VA health care and services, ending the backlog in compensation claims, and ending Veteran homelessness – both in 2015 – to fulfill our nation’s enduring commitment to veterans.

Such targets could now get a second look, particularly as the VA’s metrics for measuring success are scrutinized more closely.

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